Hospital study finds big gaps between best and worst but won’t name names

ratingsPatients need much more information in more user-friendly fashion to determine how hospitals might work best for them, a big new study finds, while also debunking a notion that’s a little hard to fathom on its face. Ordinary consumers seem clearly to understand that hospitals differ greatly in their quality, right? But this research doesn’t make the consumers’ job any easier.

The experts involved in the latest hospital research scrutinized 22 million admissions, with data from both the federal Medicare program and private insurers. They analyzed the information based on two dozen measures of medical outcomes. They took into account how sick the patients were and other factors, like age and income.

The New York Times reported on the researchers’ findings:

“Patients at the worst American hospitals were three times more likely to die and 13 times more likely to have medical complications than if they visited one of the best hospitals.”

Here’s the giant flaw in this study from the consumer point of view: The authors, to access the confidential information they relied on, can’t identify the hospitals involved, especially as to which are the “best” and “worst” and details why. They looked at hospitals’ patients, their wealth and health, and pointed to the critical qualitative role that may rest in the individual institutions’ culture and medical caregivers, especially their individual and collective skills, experiences, and approaches.

The researchers  found big quality differences in hospitals, with a huge range of potential considerations for patients. Institutions that treated high volumes of specific types of case seemed to perform better than their lower volume counterparts. (I’ve written about this issue.) The researchers said they found “select U.S. hospitals serving complex and disadvantaged patient populations that deliver outstanding risk-adjusted outcomes. Conversely, we find select U.S. hospitals serving relatively healthy and wealthy patients that deliver lagging risk-adjusted outcomes.” Further, even within some of the same hospitals, they found that institutions might have excellent outcomes, say, with heart surgeries but perform less well with knee procedures.

How are patient-consumers supposed to sort these differences out? They need more medical outcome information presented in ways that can be grasped more easily by ordinary consumers, the researchers said. They noted that many rating and ranking systems are based on measures like antibiotic administration, infections, or overall readmissions or deaths—not on specific, detailed information on outcomes in treating a given disease or performing a particular procedure. Many of the ratings offer just stars and terse explanations.

The experts also explained that they hoped the significant differences they found among hospitals in a specific area would be useful in public policy discussions, such as insurers charging lower premiums based on narrow networks (reduced choices of hospitals in a given geography). Health policy decisions cannot be based on the notion that hospitals are much the same, especially because caregivers and patients alike already know this isn’t so.

I’ve written about the challenges that patient-consumers confront when they’re trying to sort through ratings, rankings, objective information, and doggone hype to find the best hospital care they need. It isn’t easy, and all too often this task needs to occur in tough circumstance and under short time constraints. We’ve all got a lot of work to do, first to stay healthy and out of hospitals, but to get the critical information we deserve about these big, powerful institutions with such influence over our health and lives.

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